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Posts Tagged ‘deductibles’

It is the time of year where new insurance policies will be taking effect. Many companies have made changes to these policies and it is important that you as the user of that insurance policy understand what it covers.

The fact is that even if you call the customer line anything you are told can be incorrect and they will always refer you back to the written policy, which was provided when you signed up. That written policy will give you all the information about the policy, however it very long and sometimes quite confusing. This is the list of the 5 things you should know going into the New Year.

1. Is the Plan and HMO, PPO, POS or Co-insurance? Depending on the company or your choice of policies there can be a great many issues that different policies effect. What doctor you can see, if you can see a specialist prior to visiting your primary care doctor and how much you pay for each visit is controlled by the plan you sign up for. There may also be a requirement for prior authorization by the insurance company for testing, procedures or medication depending on the plan.
2. Do you have a deductible? A deductible is basically the amount of money you need to spend out of your own pocket prior to the insurance company paying for your care. This can be anywhere from $100-$5000 depending on the plan. Now there may be exceptions to the deductible. In some plan your visit to a physician will be a set amount and will not be used toward your deductible. So if you visit the doctor and have to $25 to see him that amount of money will not necessarily be applied to your deductible.
3. Do you have a Co-payment? This amount of money is the amount you pay for anything after you have met your deductible. So if your plan pays 80% of the cost for a procedure you would be responsible for 20% of the cost. This cost would be the price the insurance company has previously negotiated with the doctor’s office, and will not be the same as the cash price. It could be more or it could be less.
4. Do you have any riders to the plan? A rider is an extension to the plan that may limit or add extra care for the individual. Some plans have a rider that eliminates payment for any medical activity that involves weight loss. Others have durable medical equipment riders or nursing home riders, which limit this or exclude this type of care from being paid.
5. Do you have a separate prescription plan? Some plans use a different company to care for prescriptions. You can have a separate deductible or co-payment with this plan. It can also limit what medications they will pay for based on a specific formulary, or list of medications. The plans can also require that long term medication be handled through the mail rather then the local pharmacy.

If you do call the customer care line to get information make sure you ask for the representative’s name and the call ID. This way you can track where you got the information if you need to argue about coverage. But if you listen carefully they will always tell you that they are not responsible for the information they gave you and that you need to consult the policy itself.

It is always important for you to understand what your insurance will and will not cover. When the final bill comes you will ultimately be responsible for any money that was not covered by the insurance company. The more informed you are the less likely you will be surprised by your final payment.

There are only two more weeks left to the year and the dreaded fear of the deductible has arisen. This condition involves the realization that the new year not only brings resolutions and fresh commitments but a large financial goose egg known as the insurance deductible. This large sum of money due at the beginning of each year for healthcare expenses although is known is quite frequently unplanned for.

So I started getting the frantic phone calls this week to try and get their tests completed and billed before years end. The issues are difficult because many doctors take vacation the last weeks of the month. We do however want to help those who need it. And will try to schedule people as quickly as possible for the study. But really what we need to do is plan for the deductible so that it will not affect our healthcare.

Every year on January 1 I have a $3000 expense that involves my deductible and my son’s medication. The medication company knows this and I know this. I try to order my last does of the year as close to the end of the month as possible so I do not have deal with this right after the holidays. I also have a savings account to save for this. Each month I a small portion to this amount. This helps. I also work with the drug company to do monthly payment plans usually I will have about $1500 in the bank account and then I pay the rest off in monthly payments. So how does this pertain to you?

Well this year many people have had an increase in their deductible, and like me they had to meet their deductible twice in a 6 month period because their company changed insurers. If you need care do not hesitate to work with the people who are providing your care. Sometimes if you pay in cash up front they will give you a discount over what you would pay with your insurer. Look into care credit. It is a medical credit card that will help you to cover your shortfall. If worse comes to worse contact your local hospital’s social work department. They might have suggestions of where you might be able to get affordable care until you have met your deductible. The important thing is to make sure you get the care you need.

Your health is the one thing that when you loose there is no amount of money that will replace it. So I hope everyone has a healthy and happy holiday.